END TERM REVIEW OF THE IMPLEMENTATION OF THE PLAN FOR THE NATIONWIDE ROLLOUT OF ANTIRETROVIRAL THERAPY IN ZIMBABWE 2013-2017 LOCAL PUBLIC HEALTH SPECIALIST AIDS & TB UNIT MINISTRY OF HEALTH & CHILD CARE REPUBLIC OF ZIMBABWE September 2017
Background The Ministry of Health and Child Care introduced antiretroviral therapy into the public sector in 2004 with the aim of reducing HIV related morbidity and mortality as well as improving the quality of life for people living with HIV in Zimbabwe. Implementation was initially guided by the Rollout of ART 2004-2007 followed by the Plan for the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe, 2008-2012 then subsequently the Plan for the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe, 2013-2017. As a result of high commitment by government and its funding, technical and implementing partners at all levels, the programme has expanded rapidly over the years, from 5 sites in 2004 to nearly 1600 sites by end of 2016, including 1566 ART initiating sites. The number of people accessing ART has increased from 11,000 to over 975,567 adults and children over the same period. During implementation of the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe 2013 2017 it was noted that there were huge disparities between treatment coverage among children and adolescents when compared to adults. This realisation lead to the development of the Accelerated Action Plan for the scale up of Antiretroviral Treatment for Children and Adolescents, 2015 2018 which outlined interventions to help scale up access to ART care and treatment in this population. Through implementation of the scale up plan service delivery was rearranged to ensure identification of children living with HIV through various entry points as well as linkage to treatment and care and this initiative lead to an increase in CLHIV on treatment from 55,061 in 2014 to 66,159 by the end of 2016. Against a background of the ambitious goals set by the country to achieve the MDGs by 2015 and subsequently the SDGs by 2030, the government also developed a strategic framework for public private partnerships for TB and HIV prevention, treatment, care and support (2014 2016), to galvanize the critical input that the private sector will play in the national response. Through this framework, several partnerships with the private sector were established during implementation of the HIV care and treatment strategy which resulted in further decentralization of services and increased ART coverage for both children and adults. To address the following 3 key questions in terms of controlling the HIV epidemic: Has there been a significant change in outcomes and impact? Are these changes plausibly related to program impact? How can programs be better focused on impact going forward? The country with support from the World Health Organization and the National AIDS Council commissioned an epi and impact review towards the end of 2016. The following were some of the key findings from the assessment undertaken: HIV prevalence had remarkably declined for the periods 2000-5 2005-10 and this decline was extending up to 2015; HIV incidence had significantly reduced from 1.48 in 2011 to 0.98 in 2013 and then to 0.48 in 2016; 2
HIV related mortality had significantly been reduced [66% reduction in adult (15 49) mortality since 2003] suggesting a major impact of HIV treatment on deaths and new TB notifications [were also significantly declining; Overall the treatment cascade was showing low leakage with strong referral to care (97%), enrolment in care (88%) and some gaps from enrolment to newly initiating on ART (27%); Viral load suppression among those on treatment was relatively high (86.5%) with gaps still prevalent in viral load testing coverage (17% by end of 2016) and VL suppression among men [which was still relatively lower compared to their female counterparts]; HIV treatment cascades among key populations was showing high leakages in comparison to the general population with significant gaps noted in the younger casual sex workers (CSWs) less than 25 years. Findings from the proposed programme review are therefore expected to inform the development processes and strategies that the national programme should take up to steer the country towards meeting the 2020 Global UNAIDS 90 90 90 targets as well as the BE FREE framework superfast targets for children, adolescents and young people which it is party to. Scope of work The main role for the Local Public Health Specialist is provide local perspective and coordinate the review of the implementation of the Plan for The Nationwide Rollout of Antiretroviral Therapy In Zimbabwe, that is, effectiveness, efficiency, equity, relevance and sustainability of the HIV Care & Treatment and related programmes. More specifically, the public health specialist s roles will include: To support the lead consultant and coordinate the review process for the national OI/ART programme To consolidate and document the review findings and recommendations for the different components of the HIV care & treatment programme including clinical care, laboratory services, supply chain management, monitoring & evaluation, and linkages with other programmes and interventions To facilitate, with support from the MoHCC and partners, the activities for the review and development of the new strategic plan including: Development of tools Key consensus workshops Key Informant interviews Team meetings 3
Field visits Feedback sessions To ensure the timely submission of all the deliverables as highlighted in the general terms of reference for the review of the OI/ART programme and the development of the new strategy Expected deliverables The Public Health Specialist will contribute towards the production of the following deliverables by the review team: A comprehensive preliminary programme review report that addresses all the review objectives and detailing achievements, best practices, lessons learnt and challenges at the end of the review period A debrief PowerPoint presentation to the MoHCC management and the National Partnership Forum for TB and HIV Care & Treatment A final detailed report with an executive summary indicating identified and prioritized practical recommendations is to be submitted to the AIDS & TB Unit, MoHCC within a month after the end of the assignment. This should also be provided as both electronic and hard copies Methodology a) Desk review: Conduct an overall assessment of the OI/ART programme through a review of all the relevant documents including policy documents, annual reports, guidelines, plans or study reports b) Key informant interviews: Conduct a range of interviews with key informants at all levels of the health delivery system including managers within the MoHCC, AIDS & TB Unit, PMDs, DMOs, PNOs, DNO, Focal persons, NAC, PLHIV, Community Health Workers, Health Training Institutions, health workers, partners and key stakeholders, NATPHARM and related logistics institutions, community leaders and the beneficiaries of the services i.e PLHIV c) Field visits: Conduct site visits to a representative sample of health facilities at different levels of the health delivery system, different geographical regions, mission hospitals and the private sector 4
d) FGDs/patient interviews: This will be conducted to explore the levels of patient satisfaction at the different levels of health care Time frame The local public health expert will work with the review team for a total of twentyone (21) working days. Qualifications The expert should have the following expertise: Medical doctor with post graduate training in Public Health He/she should be knowledgeable and experienced in the area of epidemiology, programme management and monitoring & evaluation including Health Systems. The public health expert is expected to have substantial experience in conducting evaluations in Zimbabwe. He/she should have ccomprehensive knowledge and experience in HIV/AIDS prevention, treatment, care and support. Thorough public health knowledge of current HIV/AIDS issues is required. He/she should have at least 10-15 years experience in the field of HIV and AIDS. Conversant in the national HIV/AIDS policies and the operations of the health delivery system in Zimbabwe so as to assist with putting issues into context and perspective Excellent writing and analytical skills and strong oral communication skills are required Fluent in English (speaking, reading and writing) Supervision and Accountability The Local Public Health Specialist will report to the Team Leader in charge of the review process. Application Interested candidates should submit Technical and Financial Proposals in sealed envelopes mark Local Public Health Specialist and send to: UNDP Zimbabwe GFATM Programme Management Unit Block 9, Arundel Office Park, 5
Mt Pleasant, Harare Zimbabwe Att: PSM TEAM or Email: zw.bids.gfatm@undp.org Deadline for applications is Friday 29 th September 2017 at 12.00pm. Only shortlisted candidates will be contacted. 6